Provider Demographics
NPI:1104258409
Name:SHIRAISHI, LINDA T (RN, FNP, CWON)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:T
Last Name:SHIRAISHI
Suffix:
Gender:F
Credentials:RN, FNP, CWON
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:K
Other - Last Name:TUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP
Mailing Address - Street 1:1760 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1826
Mailing Address - Country:US
Mailing Address - Phone:925-373-4700
Mailing Address - Fax:
Practice Address - Street 1:4951 ARROYO RD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-9650
Practice Address - Country:US
Practice Address - Phone:925-373-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA563489163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care